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Work-related risk factors for specific shoulder disorders: a systematic review and meta-analysis
  1. Henk F van der Molen1,2,3,
  2. Chiara Foresti4,
  3. Joost G Daams1,2,3,
  4. Monique H W Frings-Dresen1,2,3,
  5. P Paul F M Kuijer1,2,3
  1. 1Coronel Institute of Occupational Health, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
  2. 2Netherlands Center for Occupational Diseases, Amsterdam, The Netherlands
  3. 3Amsterdam Public Health research institute, Amsterdam, The Netherlands
  4. 4School of Occupational Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  1. Correspondence to Dr Henk F van der Molen, Academic Medical Center, Coronel Institute of Occupational Health, PO Box 22660, Amsterdam 1100 DD, The Netherlands; h.f.vandermolen{at}


The objective of this systematic review and meta-analysis is to examine which work-related risk factors are associated with specific soft tissue shoulder disorders. We searched the electronic databases of Medline and Embase for articles published between 2009 and 24 March 2016 and included the references of a systematic review performed for the period before 2009. Primary cross-sectional and longitudinal studies were included when outcome data were described in terms of clinically assessed soft tissue shoulder disorders and at least two levels of work-related exposure were mentioned (exposed vs less or non-exposed). Two authors independently selected studies, extracted data and assessed study quality. For longitudinal studies, we performed meta-analyses and used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the evidence for the associations between risk factors and the onset of shoulder disorders. Twenty-seven studies met the inclusion criteria. In total, 16 300 patients with specific soft tissue shoulder disorders from a population of 2 413 722 workers from Denmark, Finland, France, Germany and Poland were included in the meta-analysis of one case–control and six prospective cohort studies. This meta-analysis revealed moderate evidence for associations between shoulder disorders and arm-hand elevation (OR=1.9, 95% CI 1.47 to 2.47) and shoulder load (OR=2.0, 95% CI 1.90 to 2.10) and low to very low evidence for hand force exertion (OR=1.5, 95% CI 1.25 to 1.87), hand-arm vibration (OR=1.3, 95% CI 1.01 to 1.77), psychosocial job demands (OR=1.1, 95% CI 1.01 to 1.25) and working together with temporary workers (OR=2.2, 95% CI 1.2 to 4.2). Low-quality evidence for no associations was found for arm repetition, social support, decision latitude, job control and job security. Moderate evidence was found that arm-hand elevation and shoulder load double the risk of specific shoulder disorders. Low to very-low-quality evidence was found for an association between hand force exertion, hand-arm vibration, psychosocial job demands and working together with temporary workers and the incidence of specific shoulder disorders.

  • shoulder
  • musculoskeletal disorders
  • work
  • risk factors
  • meta-analysis
  • aetiology

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  • Contributors HFM initiated the study, performed the statistical analyses and drafted the manuscript. JGD contributed to the literature search. HFM, CF and PFMK performed the study selection, data extraction and interpretation of the data. MHWFD was the principle investigator in this study. All authors made substantial contributions to the conception of the study and manuscript.

  • Funding The work was sponsored by the Ministry of Social Affairs and Employment, the Netherlands (Grant No. 5100-22709).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.